Non-white women are less likely to have apical suspension at the time of hysterectomy after controlling for geographic variations in a nationally representative cross-sectional study using HCUP

Abstract

To evaluate the differences in concurrent apical prolapse repair at the time of hysterectomy among racial groups using a nationally representative sample inclusive of all payers and patient encounters that accounts for geographic differences. This cross-sectional study uses the HCUP National Inpatient Sample, a national database of inpatient encounters that includes all payers and a representative sample within the United States. Race and ethnicity are patient reported. Hysterectomies and apical prolapse repair procedures are identified using procedural codes. Differences in concurrent apical prolapse repair with hysterectomy are analyzed by racial groups and adjusted for potential confounders. In 2017, 35,865 women underwent hysterectomy in this nationally representative sample, with 18,943 (55%) White, 7,472 (22%) Black, 5,244 (15%) Hispanic, 1,472 (4.2%) Asian, 165 (0.5%) Native American, and 1,390 (4.0%) other races. A total of 2,395 (6.9%) of women underwent concurrent apical prolapse repair at the time of hysterectomy, with Black and Native American women having the lowest rates (3.6% and 3.8% respectively) (P<0.001) (Figure 1). Among women with vaginal hysterectomies, 827 (35%) had concurrent apical repair, with the lowest rate among Native American and Black women (12% and 37% respectively) (P<0.001) (Figure 1). In multivariate regressions, Black (OR 0.60, 0.42-0.86, P=0.006), Hispanic (OR 0.73, 0.57-0.94, P=0.015), and Asian race (OR 0.48, 0.29-0.81, P=0.006) were significant predictors of lower rate of concurrent apical repair with vaginal hysterectomy after adjusting for patient, hospital, community, payer, and geographic factors (Table 1). Similar results were obtained for concurrent apical repair with any hysterectomy (Table 1). A small minority of patients undergo concurrent apical prolapse repair with hysterectomy. In this nationally representative sample controlling for not only patient characteristics, but also potential biases in practice patterns across geographic areas, payers, and hospital factors, Black, Hispanic, and Asian races remained significant predictors of lower rate of concurrent apical suspension.View Large Image Figure ViewerDownload Hi-res image Download (PPT)